Exploring the health and service utilisation of general practice patients with a history of adverse childhood experiences (ACEs): an observational study using electronic health records

OBJECTIVES: To examine the relationships between adverse childhood experiences (ACEs), chronic health and health service utilisation among a sample of general practice patients. DESIGN: Cross-sectional observational study using anonymised data from electronic health records for 763 patients. SETTING: Four general practices in northwest England and North Wales. OUTCOME MEASURES: Patient demographic data (age, gender); body mass index; self-reported smoking status; self-reported ACEs; diagnosis of chronic health conditions; current mental health problems; total number of service contacts and repeat medication use in the previous 6 months. RESULTS: A history of ACEs (experiencing abuse or neglect as a child, and/or growing up in a household characterised by violence, substance use, mental health problems or criminal behaviour) was strongly independently associated with current mental health problems, smoking and chronic obstructive pulmonary disease, showing a dose–response relationship with level of ACE exposure. Medication use and contact were significantly greater among patients with high ACE exposure (≥4 ACEs), compared with those with no ACEs. However, contrary to findings from population studies, health service utilisation was not significantly different for patients with increased ACE exposure (1–3 ACEs) and their ACE-free counterparts. CONCLUSIONS: Findings highlight the contribution ACEs make to unequal distributions of risk to health and well-being and patterns of health service use in the UK.